Although a compelling film in many ways, Dallas Buyers Club straddles a cinematic middle ground without fully committing to a single storytelling focus.

The long-languishing screenplay is based on the real life of Ron Woodroof, a Dallas electrician and rodeo aficionado whose hard-living lifestyle is upended when he contracts HIV in 1985. Although some superb acting sets the stage for an intriguing biopic, the rendering of Woodroof's life—some of it based on hours of interviews with Woodroof by screenwriter Craig Borten in 1992, with a few key components fictionalized—lands more like an issue-oriented retrospective of the despondent, deadly early years of the AIDS crisis. At the same time, however, conflating the film into an overarching account of the AIDS epidemic is undone by the film's narrow narrative scope.

That's not to say director Jean-Marc Vallée doesn't explore a number of provocative issues. We see the rapidly deteriorating Woodroof (Matthew McConaughey) as he's ostracized by his friends, evicted from his mobile home and rendered unable to find work. Moreover, his physicians stonewall him from receiving the already limited treatment options.

A round of self-administered, stolen AZT leaves Woodroof near death in a Mexican hospital. The care he subsequently receives from an American expatriate doctor (Griffin Dunne) using drugs unapproved by the Food and Drug Administration turns Woodroof on to both the need for this medicine back home as well as the money to be made from smuggling and selling them.

Woodroof launches a members-only "club" where a monthly fee gives disillusioned HIV/AIDS sufferers unlimited access to underground medications and dietary supplements that purportedly exhibit better results than the approved drugs being peddled at exorbitant prices by the pharmaceutical industry.

Woodroof's "Dallas Buyers Club" was, in fact, one of many that sprouted up across the country during this era. Throughout the film, both Big Pharma and the medical establishment are rightly taken to task for essentially acting as the very drug dealers they accuse Woodroof of being.

On the other hand, the portrait painted of Woodroof is someone who experienced a road to Damascus conversion that transformed him from a homophobic redneck into an angel of mercy exalted by the local gay community. This rendering glosses over some thorny moral questions—chiefly whether Woodroof and his back-alley dispensaries preyed on a desperate clientele whose only other alternative was being "lucky" enough to become a clinical trial guinea pig.

Still, Dallas Buyers Club survives these quibbles—as well as the presence of Jennifer Garner as a local doctor suffering a crisis of conscience—thanks to a captivating acting duo. In the performance of his suddenly rising career, McConaughey imbues the scrawny Woodroof with an intricate mix of country cocksuredness, spiraling despair and soulful compassion. Although the closest Woodroof comes to bucking bulls is a threesome just outside the rodeo ring, McConaughey—physically withered to bone and sinew—joins other cinematic deconstructions of Western masculinity, including Midnight Cowboy and Brokeback Mountain.

As good as he is, McConaughey is repeatedly upstaged by Jared Leto in the role of Rayon, a transsexual AIDS sufferer who forms a personal and professional kinship with Woodroof. Leto's transformation is even more jarring—his immersion is unlike anything this side of Heath Ledger's Joker. It's a part that spans the emotional spectrum: There are many moments of levity, while a scene where Rayon dons a suit and tie to beg his disapproving father for money is a heart-wrenching show-stopper. With a tender lilt lacquered over a perceptible Texas twang, Leto brings an impish charm and aching humanity that lends voice to the gay HIV community, reaching beyond that of a reluctant, accidental champion.